Provider Demographics
NPI:1821143124
Name:AEV INC
Entity Type:Organization
Organization Name:AEV INC
Other - Org Name:BEACON PRESCRIPTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:E
Authorized Official - Last Name:BEAUDOIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-467-2600
Mailing Address - Street 1:875 FOXON RD
Mailing Address - Street 2:
Mailing Address - City:EAST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06513-1837
Mailing Address - Country:US
Mailing Address - Phone:203-467-2600
Mailing Address - Fax:203-467-5455
Practice Address - Street 1:875 FOXON RD
Practice Address - Street 2:
Practice Address - City:EAST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06513-1837
Practice Address - Country:US
Practice Address - Phone:203-467-2600
Practice Address - Fax:203-467-5455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004116514Medicaid